Introduction
The rapid urbanization trends observed in recent decades have increased the gap between urban and rural communities, leaving rural communities behind in healthcare accessibility and technology. Rural communities see long distances to adequate care and limited access to personal and public transportation, putting rural community members in a unique bind that forces them to make difficult decisions when it comes to healthcare. Rural residents can make significant sacrifices for healthcare, or reject that care altogether because of the physical preventative barriers. Understanding the physical distance barriers to healthcare in rural communities makes the state of the issue very clear. It is most definitely a public health issue, worsening the overall healthcare of such communities as individuals who live in these communities have a far more difficult time receiving quality care compared to urban counterparts due to such physical barriers. Change is needed in both the rural healthcare infrastructure and the public transportation infrastructure in order to combat this issue, leveling out access to healthcare.
Distance Barriers to Rural Healthcare
When care becomes increasingly specialized, especially in chronic conditions, the amount of suitable providers located in rural communities decreases exponentially. With a lack of technologies and providers in rural facilities, care is diverted to the urban locations. Even when care is not diverted, distance is one of the largest barriers to healthcare in rural communities, and is one of the main reasons rural residents lack motivation to pursue follow-up visits or routine check-ups. There is a funding disparity present between rural and urban healthcare facilities, and Cynthia Songs, a rural community resident, explains the resource disparity between rural and urban healthcare facilities in an interview with the Southern Oral History Program [1]. She notes that there were a lot more “resources for them as far as being- because that’s a major medical area” (Songs p. 25). She continues that “you may have to travel two or three hours to get to Chapel Hill or to Duke or to some big place” (Songs p.25). This again puts rural residents in a bind where urban facilities have better healthcare, but it is difficult to make it to those urban facilities. Songs’s testimony shows that it becomes very difficult to be an active member of care when the location of the care is so far from the patients’ residences.
Personal Transportation Barriers to Rural Healthcare
Even though distance is a major factor when it comes to the decision-making of rural residents to pursue healthcare, a prior question is whether or not they have the personal means of transportation to travel the long distances. This problem is uniquely worse for rural residents as Samina Syed [2] notes that “rural patients reported more problems with transportation and travel distance to health care providers and had a higher burden of travel for health care when measured by distance and time traveled.” External considerations have to be made, specifically when it comes to having a personal driver’s license or having friends or family to drive patients to healthcare appointments. A study conducted by Thomas Arcury [3] noted that “having a personal driver’s license doubled the number of chronic care and regular care visits in a year,” and “family and friends continue to play important roles in rural life, increasing by half again the number of chronic health care visits.” This, however, poses an additional barrier as patients inevitably have to schedule appointments around other individual’s schedules. Thomas Arcury continues that “people who need to rely on others for a ride are more likely to find it difficult to obtain transportation.” This makes it difficult to have appointments and follow-up appointments for adequate care. An external factor to take into account is socioeconomic status as these personal transportation barriers are amplified with a low SES. Syed’s research [2] shows that “patients with a lower [socioeconomic status] had higher rates of transportation barriers.” Personal transportation is a key consideration when discussing rural healthcare physical barriers as increasing transportation can increase healthcare accessibility.
Public Transportation Barriers to Rural Healthcare
When individuals do not have access to the personal transportation methods to travel to healthcare appointments, the use of public transportation is employed. However, patients in rural areas have run into systemic issues when utilizing public transportation, noting its inconvenient service as a barrier that prevents its use to make it to healthcare appointments. A study conducted by Jeremy Mattson [4] investigated the role of public transportation in rural healthcare and proved that current public transportation operates on “inconvenient schedules” and there are incongruences with “transit and medical schedules.” Patients in rural communities have cited the reason they missed healthcare appointments is because of a lack of buses operating on a timely manner, specifically “infrequent service, service not going where they need to go, lack of door-to-door service, and difficulty getting information about the service” (Mattson). The problem is multidimensional again because patients either cannot make it to their appointments, or have difficulty scheduling them because of the inconsistencies with transportation. This problem worsens with essential follow-up appointments, heightening the importance of having reliable transportation. Increasing public transportation can ease the scheduling issues in rural communities.
Community Support
The issue of bridging the transportation gaps for rural communities has received little solution from governmental policy makers on the local and federal level. The actions of community members with first-person experiences are extremely valuable in determining the ways to move forward. Ebony Brame’s account in the Southern Oral History Program [5] is a prime example of individual action to combat a systemic issue. Her vision is to create a private transportation service for the aging population of her rural communities that offers cheaper and more efficient service. This would help those who lack the financial support to engage in healthcare.
“Sometimes their medications are so expensive to get after they go to the doctor, that they can’t afford to take it or buy it in order to take it, and it’s unfortunate” (Brame p. 21).
By providing a “medical transportation business” she could lower the cost of healthcare and increase its accessibility in rural areas (Brame p. 21). A lack of governmental funding could make this project difficult to achieve, but the message Brame portrays is that bridging the transportation gap is an important step forward when it comes to the healthcare of those living in rural communities.
Conclusion
Because of the present distance barriers to rural healthcare, solutions must come to minimize them and ensure equal access to quality healthcare. An individual’s geographic locations should not be the defining factor in the amount and quality of care they receive because healthcare is an innately human right that all humans should have access to. The reality is that the course of sickness in rural areas is vastly different than in urban areas due to a resource disparity that can be attributed to a lack of funding and providers in rural areas. For many individuals living in rural areas, the right to healthcare is distant in itself. The sheer distance to quality care, coupled with the fact that there is a lack of transportation infrastructure makes it so that individuals are isolated from healthcare as a whole. As illness becomes chronic and the care required is specialized, the problems only get worse. Any delay in the process of care has significant negative consequences that make current health conditions significantly worse.
Solutions that minimize the distance between patient and provider and allow the patients to rely less on public transportation are key areas of focus in this specific issue. Therefore, solutions like telehealth that include “video conferencing, remote monitoring, and other disease management support at a distance” should be used more predominantly with individuals living in rural communities( Syed)[2] . This is key in preventative care like doctor check ups, making it so that there is less of a need to travel long distances for care that is needed when illness turns chronic. In addition, increasing the number of rural providers can ease this issue for those living in rural communities by decreasing the distance it takes for them to make it to healthcare facilities. Both of these issues alleviate the effect of physical barriers on rural healthcare.
Ensuring equal access to healthcare is one of the most significant public health issues in the status quo. Without transportation, there are significant issues in clinical interventions that lead to “a lack of appropriate medical treatment, chronic disease exacerbations or unmet health care needs, which can accumulate and worsen health outcomes” as Samina Syed [2] explains. Addressing these issues in policies can help to make targeted solutions in which the needs of rural communities are met. Because equal access to healthcare is important to live a healthy life, promoting policy changes and solutions that have rural communities at its heart, more individuals can live healthier lives.